Additional Malignant Breast Lesions Detected on Second-Look US After Breast MRI vs. Additional Malignant Lesions Detected on Initial US in Breast Cancer Patients: Comparison of US Characteristics

Abstract

Purpose: The purpose of our study was to review and compare the US findings of synchronous malignant breast lesions other than the index cancer additionally detected on second-look US with those detected on initial US, and therefore to determine differing characteristics that may aid in diagnosis and essentially improve the performance of the initial US examination.

Materials and Methods: A retrospective review of 39 mammographically occult synchronous malignant lesions other than the index cancer from 38 patients was performed (21 lesions: detected on second-look US, 18 lesions: detected on initial US). All patients underwent initial mammography, bilateral whole breast US (BWBU) and breast MRI, and all lesions were confirmed pathologically by biopsy or preoperative localization.

Results: Additional malignant breast lesions detected on both initial US and second-look US tended to be subtle and often did not show classic malignant findings. Second-look US lesions (median, 7.0 mm; range, 3 – 22 mm) tended to be smaller than initial US lesions (median, 9.0 mm; range 3 – 45 mm), although the difference was not statistically significant (p = 0.134). Second-look US lesions also showed no posterior acoustic features (p = 0.037) and a significantly higher proportion of lesions with circumscribed or indistinct margins compared to initial US lesions (p = 0.042). Second-look US lesions were significantly subareolar or relatively far (> 5 cm) from the nipple than initial US lesions (p = 0.048).

Conclusion: Second-look US lesions showed more subtle findings of posterior acoustic features and margins, and tended to be subareolar or relatively far from the nipple compared to initial US lesions. However, both groups showed subtle US findings and there was no significant difference in other features.

Zusammenfassung

Ziel: Ziel der Studie war der Vergleich von US-Befunden synchroner maligner Mammaläsionen, die nach der Diagnose des Indexkarzinoms im Second-Look US zusätzlich diagnostiziert wurden im Vergleich zu solchen, die unmittelbar im initialen US dargestellt werden konnten. Hiermit sollten unterschiedliche Charakteristika bestimmt werden, die bei der Diagnosestellung unterstützen und das Ergebnis der initialen US Untersuchung essentiell verbessern können.

Material und Methoden: Bei 38 Mammakarzinom Patienten erfolgte eine retrospektive Durchsicht 39 mammografisch okkulter Läsionen, die synchron mit dem Indexkarzinom assoziiert waren (21 Läsionen: Detektion mittels Second-Look US, 18 Läsionen: Detektion im initialen US). Alle Patienten erhielten initial eine Mammografie, eine bilaterale Mamma Sonografie und eine Mamma-MRT, und alle Läsionen wurden pathologisch durch eine Biopsie oder präoperative Lokalisierung bestätigt.

Ergebnisse: Zusätzliche maligne Mammaläsionen, die mittels initialem US oder im Second-Look US detektiert wurden, waren häufig dezenter und zeigten nicht die klassischen Malignitätskriterien. Die mittels Second-Look US diagnostizierten Läsionen (Median, 7.0 mm; Range, 3 – 22 mm) waren kleiner, als solche, die im initialen US dargestellt werden konnten (Median, 9.0 mm; Range 3 – 45 mm), obschon der Unterschied nicht signifikant war (p = 0,134). Second-Look Läsionen zeigten keine Schallfortleitung (p = 0,037) und einen signifikant größerer Anteil an Läsionen hatte einen begrenzten oder unscharfen Rand im Vergleich zu Läsionen, die sich im initialen US darstellten (p = 0,042). Second-Look-Läsionen waren signifikant häufiger subareolär oder relativ weit distant (> 5 cm) von der Mamille entfernt gelegen im Vergleich zu den initial detektierten Läsionen.

Schlussfolgerung: Mit Second-Look US diagnostizierte Läsionen zeigten dezentere Befunde bezüglich Schallfortleitung und Berandung und lagen eher subareolär oder relativ weit von der Mamille entfernt im Vergleich zu Läsionen im initialen US. Insgesamt zeigten beide Gruppen dezente US Befunde und es ergaben sich keine signifikanten Unterschiede anderer US Charakteristika.

Key words

breast - ultrasound - second-look

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